UB geriatrics expert explains why in Annals of Internal Medicine editorial
By the University at Buffalo
A study published this week in the Annals of Internal Medicine that shows no benefit from higher doses of vitamin D in the frail elderly, while of interest, is not the final chapter on how vitamin D affects this population, according to an editorial in the same issue of the journal.
In his editorial, Bruce Troen, M.D., professor and chief of the division of geriatrics and palliative medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, describes the primary outcome of the National Institutes of Health-funded Study to Understand Fall Reduction and Vitamin D in You (STURDY).
Troen is an expert in geriatrics with a background in molecular biology and biochemistry. He studies the biology of aging, frailty, osteoporosis and vitamin D.
The two-year study was designed to determine whether vitamin D3 supplementation reduces falls in community-dwelling adults 70 years of age and older who are at elevated risk for falls and whose blood levels of vitamin D may be insufficient.
Troen explains the well-executed study found participants assigned to the groups that took either 2,000 or 4,000 international units (IUs) a day had a statistically significantly greater risk for hospitalization or death than those in the group taking 200 IUs a day.
“These data reveal no benefits from higher-dose vitamin D supplementation and even raise concerns that high doses may have deleterious effects,” Troen writes.
However, he adds, that finding is not conclusive because of several limitations. For one thing, the control group received 200 IUs of vitamin D3, which brought average total daily vitamin D3 intake including dietary intake to the recommended daily allowance of approximately 800 IUs. In addition, vitamin D levels in the blood increased in all participants in the study, which, Troen notes, prevented the study from revealing how frail elderly individuals with frank deficiency of vitamin D might benefit from supplementation.
A lack of information on comorbid conditions, medications that can cause falls and methods of assessing cognitive impairment also limit the power of the study’s findings, Troen says, in addition to the fact the study lasted for two years. Animal model research Troen and colleagues in the department of medicine at UB recently completed showed vitamin D insufficiency over the equivalent of 30 years negatively impacts physical performance.
So, Troen concludes, the question of whether or not adults should take vitamin D3 supplements to prevent falls is far from settled. He discusses a number of other trials that have failed to show that supplementation prevents falls but notes they also failed to demonstrate that the supplementation was harmful.
What will prevent falls in the frail elderly? Troen concludes the answer must be multifaceted, including medication management, assessment of cognition and blood pressure, exercise or physical therapy, disease management, vision care, home safety modifications and potentially vitamin D supplementation. The relationship between exercise and vitamin D status is another important factor that must be further studied, according to Troen.
Troen helped found and is director of UB’s Center for Successful Aging, an interdisciplinary center that seeks to conduct community-responsive research among UB faculty and its community partners to solve challenges facing older adults.
He is a physician-investigator with the Veterans Affairs Western New York Healthcare System and director of geriatrics services at Erie County Medical Center. He is also the co-director of UB’s Center of Excellence in Alzheimer’s Disease and an investigator on SNAP, the SUNY Network Aging Partnership: Investigating Frailty and Enhancing Lifespan Across the Health Spectrum, both funded by New York state. He is chief of the division of geriatrics and palliative medicine with UBMD Internal Medicine.